I really appreciate the helpful suggestions from the list. Rene Hartel suggested a paediatric condylar blade plate. Dr Gonzales showed a similar case treated the way I was planned to, but his case had healed the epiphysis. Dr Abuhassan suggested a T plate. The difficulty with the blade plate idea is that there may not be room to put the blade in front or behind the existing screw. I will have that on hand (and T plates) as I like the idea of leaving the epiphysis alone and not changing the screw. Another thought is "Schulies" which convert a standard plate into something more like a  condylar plate. Follow-up will be provided.

I did a quick check into Medline and found this complication is reported but very rare. (1/308 hips reported from Toronto by Riley et al 1990). Canale et al (1994) also described it as a complication of unused drill holes. I wasn't present at the original surgery but the surgeon is a consultant with 15 years experience. None the less it isn't only residents who make extra drill holes and this case may serve to emphasize that we shouldn't. The bibliography from Medline which I looked at is at

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Link&db=PubMed&dbFrom=PubMed&from_uid=7962506 

Post-op Xray.

Nov 28th 2000 (6 week post operation) shows the fracture to be well healed. The patient is comfortable. She has lost external rotation. Internal rotation is similar to the normal left side. She has been allowed to bear weight and undertake physiotherapy. She is not tender over the plate but I anticipate that it will cause crepitus when she externally rotates the hip. Follow-up in six months with a view to removing all the hardware if the epiphysis is fused.

Myles Clough mylesclough@shaw.ca
Orthopaedic Surgeon, Kamloops, BC, Canada
Editor Orthopaedic Web Links, (OWL), http://owl.orthogate.org
Editor, Orthopaedic Rare Conditions Internet Database (ORCID) http://www.orthogate.org/orcid/index.htm
CV http://myles.orthoweb.org/cv.htm